Randomized Comparison of Distal and Proximal Cerebral Protection During Carotid Artery Stenting

Autor: Luiz Antônio Pezzi Portela, Ângela Tavares Paes, Samuel Martins Moreira, J. Ribamar Costa, J. Eduardo M. R. Sousa, Amanda G. M. R. Sousa, Silvia Judith Fortunato de Cano, Manuel Cano, Alexandre Abizaid, Antonio Massamitsu Kambara
Rok vydání: 2013
Předmět:
Male
medicine.medical_specialty
Time Factors
Carotid arteries
medicine.medical_treatment
Carotid endarterectomy
Embolic Protection Devices
Brain Ischemia
symbols.namesake
Predictive Value of Tests
Risk Factors
medicine
Humans
Carotid Stenosis
Prospective Studies
Poisson regression
Propensity Score
Stroke
Aged
Chi-Square Distribution
carotid artery stenting
medicine.diagnostic_test
business.industry
Angioplasty
Magnetic resonance imaging
Middle Aged
medicine.disease
diffusion-weighted MRI
Diffusion-Weighted Magnetic Resonance Imaging
Surgery
Diffusion Magnetic Resonance Imaging
Logistic Models
Treatment Outcome
Cerebrovascular Circulation
Asymptomatic Diseases
Multivariate Analysis
Cohort
Propensity score matching
symbols
Female
Stents
Radiology
Cardiology and Cardiovascular Medicine
business
cerebral protection device
Brazil
Zdroj: JACC: Cardiovascular Interventions. 6:1203-1209
ISSN: 1936-8798
Popis: ObjectivesThis study sought to randomly compare cerebral protection with ANGIOGUARD (Cordis Corporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa, California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions were analyzed.BackgroundThe choice of the type of cerebral protection during CAS is controversial.MethodsFrom July 2008 to July 2011, 60 patients undergoing CAS were randomized to ANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwent DW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protection used analyzed the images. Univariate and multivariate logistic models were fitted to analyze new ischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due to differences between the groups. For the number of lesions, we used Poisson regression models.ResultsNew ischemic lesions seen on DW-MRI were present in 63.3% of the ANGIOGUARD group versus 66.7% of the Mo.Ma cohort (p = 0.787). The number of ischemic cerebral lesions per patient, when present, was significantly lower in the Mo.Ma group (a median of 6 lesions per patient vs. a median of 10 in the ANGIOGUARD, p < 0.001). Most lesions were small (60%, but the number of lesions per patient was greater in the ANGIOGUARD group. No death or disabling stroke occurred during at least 1 year of follow-up in both cohorts.
Databáze: OpenAIRE
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